多系统萎缩患者肌少症的患病率及相关危险因素分析

Prevalence and risk factors of sarcopenia in patients with multiple system atrophy

目的揭示多系统萎缩(MSA)患者的肌少症患病率,并探讨影响患者生活能力和运动能力的肌肉相关危险因素。方法本横断面研究连续纳入自2022年10月至2023年12月北京协和医院帕金森病(PD)及运动障碍多学科门诊就诊的患者,搜集其人口学数据、病程;应用改良Barthel指数评分标准(简体中文版)评估参与者的生活能力;通过统一帕金森病评分量表评估运动障碍和非运动症状的严重程度;并通过生物电阻抗法分析人体成分,握力,SARC-F评分评估患者的肌肉情况,并根据欧洲老年肌少症工作组(EWGSOP2)进行肌少症和肌少症前期的诊断。结果本研究纳入44例患者,8例(18.8%)诊断为肌少症,17例(38.6%)为肌少症前期,19例(43.2%)肌肉情况正常。三组患者的疾病相关临床特征存在显著差异,肌少症的MSA患者年龄更大(P<0.01),体质量指数(BMI)更低(P<0.01),疾病症状评分(P<0.01),SARC-F评分(P<0.05),活动能力评分(P<0.01)更差,并有着显著减低的去脂体质量(P<0.01)和相位角(P<0.05)。回归分析显示,SARC-F评分、握力、四肢骨骼肌指数,去脂体质量等均是影响MSA患者生活能力和运动能力的独立危险因素。结论MSA患者肌少症的患病率较高。在MSA患者中,肌肉减少与更严重的临床特征和更低的生活能力密切相关,是生活能力和运动功能下降的独立危险因素。

Objective To find the prevalence of sarcopenia in patients with multiple system atrophy(MSA)and to explore the muscle related risk factors that affect the ability if living and exercise of patients.Methods Through a cross-sectional study,patients with Parkinson's disease(PD)and movement disorders who visited the multidisciplinary outpatient clinic of Peking Union Medical College Hospital from October 2022 to December 2023 were included.Their demographic data and disease duration were collected.The modified Barthel Index(simplified Chinese version)was applied to evaluate the participants'living ability.The severity of movement disorders and non-motor symptoms were evaluated by the Unified PD rating scale.The body composition,grip strength,SARC-F score were used to evaluate the muscle condition of patients and the diagnosis of sarcopenia and pre sarcopenia were made according to EWGSOP2.Results Among 44 patients included in this study,8(18.8%)were diagnosed with sarcopenia,17(38.6%)were pre-sarcopenia and 19(43.2)had normal muscle condition.There were significant differences in disease-related clinical characteristics among the three groups.MSA patients were characterized by older age(P<0.01).They had lower BMI(P<0.01),and worse disease symptom score(P<0.01),SARC-F score(P<0.05),and activity score(P<0.01),significantly reduced fat removal weight(P<0.01)and phase angle(P<0.05).Regression analysis showed that SARC-F score,grip strength,limb skeletal muscle index and fat free weight were all independent risk factors affecting the ability of living and exercise of MSA patients.Conclusions The preval-ence of MSA sarcopenia is higher and sarcopenia is closely associated with more severe clinical illness and lower living ability.It is an independent risk factor for increased living ability score and motor function score.